The “Anterior Development And Postural Trainer-Landing Gear Reminder” referred to herein as (ADAPT-LGR) is a new appliance used as part of an overall treatment called Orthotropics®, which was developed about 50 years ago. It is a treatment which recognizes that all malocclusions have the common feature of the upper jaw being recessed relative to an ideal. It recognizes that the major cause of malocclusion is poor rest oral posture, usually secondary to airway issues. Proper rest oral posture means that at rest 1) The teeth are lightly together 2) The tongue is firmly against the palate with the tip of the tongue immediately behind the upper front teeth 3) The lips are together without strain.
The first thing to happen in all malocclusions is that the upper front teeth are not properly supported by the tongue and these front teeth begin to fall down and back from their ideal positions in the face. The lower jaw will also fall down and back as the upper jaw falls back. The exact nature of every malocclusion depends on exactly how the jaws are held at rest. For instance, a patient who has their mouth hanging open all the time will likely develop a long face and an open-bite tendency. A patient who has the lips together, but the tongue postured between the back teeth will develop a deeper bite (front teeth overlapping) and probably a shorter face than someone whose lips are apart all the time. There are many types of malocclusions with different variations, but none would develop if the teeth at rest were together, the tongue to the palate, and the lips together without strain.
Many appliances in orthodontics have been used to try to develop the lower jaw forward. Many of them have originated in Europe and made their way to the U.S. at varying times over the past century. They are all called “functional appliances” in that their supporters feel that they are a changing “function” (active process). All of these appliances posture the lower jaw forward, and in one way or another, connect the lower jaw to the upper jaw. The process is generally referred to as Functional Jaw Orthopedics (FR)). All tend to have a “headgear effect”. This means that the upper jaw will move back slowly over time as the muscles of the lower jaw pull the lower jaw back, the force from the lower jaw being applied through the appliance to the upper jaw. None of the proponents of these appliances suggest moving the upper jaw forward before attempting to move the lower jaw forward. The best case scenario is that they are attempting to move the deficient lower jaw forward to an already deficient upper jaw. With the headgear effect making the upper jaw even more deficient there is very little forward development of the lower jaw. Among the appliances which attempt to do this are the Bionator, Activator, Orthopedic Corrector, Herbst, Twin-Block, Forsus, MARA, Frankel, etc. There are other less common ones, as well.
Orthotropics® has a goal, not of changing “function” (an active process) but “posture” (an habitual rest position). The goal is to correct poor rest oral posture, and the approach is therefore called “postural”. The appliances are “postural” appliances as opposed to “functional” appliances. The idea is that the jaw will ultimately assume the position it is held in most of the time. Orthotropics® has at its core the idea that the maxilla always needs to be developed upward and forward before the mandible is developed forward. This often involves moving the upper teeth forward 8-10 mm. prior to moving the lower jaw forward. In all cases the upper jaw is also expanded laterally dramatically (often in excess of 10 mm.) so that the tongue can ultimately be properly fit to the roof of the mouth and stay there. In many children today, the upper jaw has become so narrow due to poor rest oral posture that the tongue simply cannot fit into the palate and remain there at rest. The maxilla must be expanded so that the tongue can be placed there and learn to stay there at rest.
The Hang Expancer, described in the parent application, develops the maxilla laterally and anteriorly. After the maxilla has been properly developed upward and forward the patient has traditionally been given a Stage III or Stage IV Biobloc, (names for the appliances used for this purpose) to posture the lower jaw forward. They are similar to all “functional” appliances with one dramatic difference. The Stage III or Stage IV appliance has large plastic flanges which protrude down from the appliance to the floor of the mouth. They are called “soft locks” because they extend down to the soft tissue in the floor of the mouth. The flanges (or soft locks) are adjusted by adding acrylic or a hydroplastic material to the acrylic so that they “engage” the soft tissue of the lower jaw. If the jaw falls back these “soft locks” cause discomfort to the soft tissue and the patient must learn to keep their lower jaw ahead of them. The patient learns to posture their jaw in one single position that is dictated by the appliance because it is uncomfortable if they do not. If the patient does this long enough the lower jaw eventually ends up in that position.
Because a child will feel discomfort if their lower jaw falls back this negates or dramatically reduces the headgear effect of “functional” appliances. Because the maxilla has already been developed forward (with the Hang Expancer) and the headgear effect is eliminated or reduced with this appliance sequence, the face ends up with both jaws further forward. The jaws are more balanced and the airways have been shown to be better on average.
There are some very distinct disadvantages to the Stage III and Stage IV appliances, discussed above. Disadvantage number one is that they are big. The extensions which hang down (“soft locks”) make the Biobloc appliances very large, and they look foreboding. Patients often say, “You're going to put that in my mouth”. The best part of the new ADAPT-LGR appliance of this invention is that the appliance looks like a very slightly “fat” version of the retainer, which the patient is wearing after they have stopped wearing the Hang Expancer. A child is easily used to this appliance without any of the fear of, “that is too big for my mouth”.
Disadvantage number two of the Stage III and Stage IV appliances, are that they cause gagging rather frequently. The posterior soft locks rather frequently cause the patient to gag when the appliance is first inserted. Sometimes this experience alone is enough to cause a child to terminate the treatment immediately.
Disadvantage number three is that the locks are there even though the patient doesn't need them initially. The soft locks are not needed when the appliance is first inserted. The soft locks are “activated” when the child is accustomed to wearing the appliance, usually about after a week or two.
Disadvantage number four is that the soft locks are not easy to move forward on the appliance and that must be often done. Many patients will have a space of 10+ mm. for the lower jaw to move forward. Orthodontists can only posture the lower jaw forward easily about 5-6 mm, at a time. The patient must learn to adapt to the moderately advanced position before they can tolerate the lower jaw even further forward. The “soft locks” on Stage III and Stage IV appliances are made in the position that is determined by the first positioning forward of the lower jaw. In subsequent adjustments of the lower jaw forward, the mandible can be postured further forward, but the “soft locks” on the appliance remain in that initial position. To really engage the lower jaw and cause the patient not to fall back, they must be adjusted forward and they are not easily adjustable. Adjustment can require a separate laboratory procedure where the appliance must be taken away from the patient for a few days to be reprocessed by the lab. This is expensive, time consuming and a waste of time. The doctor is inclined not to do it but will get less than superior results if they don't.